Provider Demographics
NPI:1619927316
Name:PIEDMONT ONCOLOGY SPECIALISTS
Entity type:Organization
Organization Name:PIEDMONT ONCOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:CALDWELL
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA
Authorized Official - Phone:704-225-8966
Mailing Address - Street 1:1650 FAULK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5263
Mailing Address - Country:US
Mailing Address - Phone:704-225-8966
Mailing Address - Fax:
Practice Address - Street 1:1650 FAULK ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5263
Practice Address - Country:US
Practice Address - Phone:704-225-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016A7Medicaid
NC89016A7Medicaid
NC4626360002Medicare NSC